Lam - Hip - Expectant Mgmt - 2009
-
Upload
ana-liz-chavez-velasquez -
Category
Documents
-
view
218 -
download
0
Transcript of Lam - Hip - Expectant Mgmt - 2009
-
7/25/2019 Lam - Hip - Expectant Mgmt - 2009
1/36
Hypertension in Pregnancy, 28:312347, 2009
Copyright Informa Healthcare USA, Inc.
ISSN: 1064-1955 print / 1525-6065 online
DOI: 10.1080/10641950802601252
LHIP1064-19551525-6065Hypertensionin Pregnancy,Vol.1,No.1, December 2008: pp. 161Hypertensionin Pregnancy
Expectant Managementof Severe PreeclampsiaRemote from Term:A Structured SystematicReviewEarly Care of Expectant PreeclampsiaMagee et al.
L.A. Magee,1,2,3,4P.J. Yong,2V. Espinosa,4A.M. Ct,1
I. Chen,2and P. von Dadelszen2,3,4
1Departments of Medicine, University of British Columbia, Vancouver, BC, V6H 3N1,Canada2Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, V6H3N1, Canada3Population and Public Health, University of British Columbia, Vancouver, BC, V6H3N1, Canada4CFRI Centre for Applied Health Research and Evaluation, University of BritishColumbia, Vancouver, BC, V6H 3N1, Canada
Objective: To compare outcomes associated with expectant vs. interventionist care of
severe preeclampsia in observational studies. Data Sources: Medline (01/198007/
2007), bibliographies of retrieved papers, personal files, Cochrane Database of
Systematic Reviews. Study Selection: Expectant or interventionist care of preeclampsia
at
-
7/25/2019 Lam - Hip - Expectant Mgmt - 2009
2/36
Early Care of Expectant Preeclampsia 313
preeclampsia or HELLP
-
7/25/2019 Lam - Hip - Expectant Mgmt - 2009
3/36
314 Magee et al.
expectant care of severe preeclampsia remote from term, and compare these
with the published observational experience with a policy of interventionist care.
METHODS
We searched OVID Medline (01/01/1980 to 13/07/2007), with the assistance of a
librarian (Tricia Yu, Eric Hamber Library, BC Womens Hospital, Vancouver)
and using the following keywords: {pregnancy, pregnancy complications,
pregnancy trimesters, pregnancy, or multiple} AND {preeclampsia, preec-
lampsia, pregnancy toxemias, or hypertension} AND {early intervention, early
delivery, interventionist, aggressive, active management, delayed interven-tion, delayed delivery, conservative management, expectant management,
temporizing management, temporising management, temporizing treatment,
or temporising treatment}. The following were also reviewed for additional
studies: personal files and bibliographies of retrieved papers, reviews in the
Cochrane Database of Systematic Reviews, review articles, and guidelines.
Our inclusion criteria were: inception from 1980, women with severe
preeclampsia remote from term [
-
7/25/2019 Lam - Hip - Expectant Mgmt - 2009
4/36
Early Care of Expectant Preeclampsia 315
variables of study characteristics (country, design), participants (exclusion of
HELLP syndrome), and intervention (policy/protocol, a priori indications for
delivery, stabilization prior to expectant care, details of intervention, and use
of MgSO4 and/or corticosteroids) was not possible as no more than 25% of
studies provided sufficient information on variables of interest.
RESULTS
Through Medline (19802007), we identified 270 potentially relevant articles.
Figure 1 details reasons for exclusion and the addition of 28 papers from review
of the bibliographies and personal files of LM (734); these papers included
Figure 1: Consort diagram: Search strategy.
Potentially relevant citations identifiedfrom electronic search (N=270)
Citations excluded (N=101)Reasons:
RCT of aggressive vs. expectant management (N=2)
Not English/French(N=23)
Review article/editorial/letter (N=51)
Case report (N=24)Survey(N=1)
Animal study(N=1)
Citations excluded (N=125)
Reasons:Not earlypreeclampsia(N=52)
Not expectant management (N=68)
Cohort recruited before 1980 (N=5)
Studies retrieved for furtherevaluation (N=169)
Citations included from reviewof files/bibiographies (N=28)Please see text for citations.
Studies INCLUDED (N=72)
-
7/25/2019 Lam - Hip - Expectant Mgmt - 2009
5/36
316 Magee et al.
RCTs of antihypertensive vs. other therapy in which expectant care was applied
to women in both groups; each arm of the trial was treated as a separate cohort.
For expectant care, there were 39 cohorts (49 publications) for severe preec-
lampsia at
-
7/25/2019 Lam - Hip - Expectant Mgmt - 2009
6/36
317
Table1:Stu
diesofexpectantorinterven
tionistcareofseverepreecla
mpsiaremotefromterm.
Study
(country)
Recruitment
interval/
Design
Nwomen/T
ype
ofPET*
GAat
recruitment
(wk)
Expectan
tor
interventionist
care
(Description)
Expectant
careafter
stabilization?
Outcom
es
Notes(includingoverlapping
studies)
Banias1992
(USA)
06/198307/
1988Retro
cohort
N=67Severe
PET(includ
ed
HELLP)
2632
Expectant
(Poor)
Unclear
Materna
l
Fetal
Mostwomenweretransfe
rred
forcareafterexpectantcare
atanotherinstitution
Begum200
2
(India)
01/199810/
2000Pros
cohort
N=51Severe
PET(includ
ed
eclampsia)